In his recent blog, A Better Way Forward, Rep. Miller, Chairman, House Veterans Affairs Committee, raises several important points regarding the care we provide our veterans. First and foremost, he asks us to go outside our comfort zone and keep an "open mind." Here are a few of his points: the VA does not have the capacity to handle the number of veterans needing mental health treatment, especially the 40% living in rural areas; we don't need a new bureaucracy; and a solution does not require complex coordination among myriad federal institutions. He proposes that:
• The VA utilize a network of providers that is already in place and already works with our military and their families, such as TRICARE, which would more than double VA's mental health care capacity overnight.
• We support veterans who elect to receive care from faith-based and community groups that support government efforts, given that our communities serve as a bridge to government and private services and it is to those communities that our veterans return and where they often first turn for help.
• We effectively address the stigma associated with receiving help.
Rep. Miller concludes: "So, we have a choice. We can continue to keep trying the same old ideas over and over again, getting the same result and keeping the status quo. Or we can take action and try a new approach, an approach that expands access to care and brings community partnerships into the equation to combat suicide, and hopefully decrease the stigma of mental injuries."
Well said. In a spirit of dialogue, I want to address a few additional points:
1. Mental health treatment does not equate with one-to-one psychological counseling and medications. There are proven evidence-based, integrative psycho-educational and psychosocial community-based practices and programs that augment, add value to, and reduce the need for and expense of, traditional mental health treatment. VA and DoD send thousands of service members, veterans, families and providers to such innovative programs at no cost to the participants or to themselves.
2. Let's be clear: there is a woeful dearth of substantive collaboration (read staffing, programming, resources, facilities) among VA, DoD and such proven community programs, despite what's been written to the contrary about partnerships. When high level staffers at government agencies say that they are afraid of "getting in trouble" over such collaborations -- with legislators in one case, of all people -- we know two things. One, there's something terribly awry between the public message and the actual reality, and two, coordination among Congress, DoD and VA does matter.
3. Congress has been clamoring for years for recommendations from VA and DoD about the best reintegration programs to scale up and fund. "Best in class" is a phrase heard a lot these days inside the beltway and in the private sector, among corporations and foundations seeking to make a real difference. Although DoD and VA cannot endorse programs, a comprehensive study of thousands of post-deployment reintegration programs has been recently completed by the DCoE, the congressionally funded and mandated DoD and VA agency established to identify, study and disseminate best practices for psychological health and TBI. But, communication is so poor that few if any in Congress, the VA and the DoD have read the study or even know about its existence!
Let's take an example. The Coming Home Project is well known in DoD, VA, Congressional, Veteran Service, and CBO circles. Coming Home was among the eight programs featured in the DCoE's definitive report: the only one of the eight that met all the DCoE criteria and best practice recommendations for reintegration programming and whose outcome results are to be published in a peer reviewed scientific journal. The DCoE doesn't endorse, but follow the links and you'll find it's all there.
Leveraging and supporting cost effective, community-based, value added, research-proven, peer-reviewed, nationally recognized best practices that have successfully served the reintegration needs of thousands of veterans, service members, their families and their providers from 45 states for over five years just makes sense. But in today's divisive governmental atmosphere, making sense, like cultivating an open mind, as Rep. Miller suggests, cannot be taken for granted. We have to go outside our comfort zones to see what's hidden in plain sight, right before our eyes. And then we need to act wisely and boldly.